超声心动图定量评估二尖瓣反流程度的质量控制  

Quality control of quantitative assessment of mitral regurgitation by echocardiography

作　　者：钟露 曹省[1] 宋宏宁[1] 陈金玲[1] 周青[1] Zhong Lu;Cao Sheng;Song Hongning;Chen Jinling;Zhou Qing(Department of Ultrasonography,Renmin Hospital of Wuhan University,Ultrasound Imaging Diagnostic and Therapeutic Quality Control Center of Hubei Province,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院超声影像科、湖北省超声影像诊断与治疗质量控制中心,430060

出　　处：《中华医学超声杂志（电子版）》2023年第7期705-711,共7页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的总结二尖瓣反流(MR)定量评估过程中存在的问题及改进措施。方法回顾性分析武汉大学人民医院2021年8月至2023年4月行MR评估患者的图像序列,共计196例患者,2021年8月至2022年8月期间107例患者为质量控制前组,2022年9月至2023年4月期间89例MR患者为质量控制后组。依据2017年版美国超声心动图学会指南将MR程度分为4个等级(轻度、中度、中-重度、重度组)。统计各分级组内4项定量参数所属分级与反流程度的不一致性,包括缩流颈宽度(VCW)、有效反流口面积(EROA)、反流容积(RVol)和反流分数(RF),不一致性分为完全一致(4项参数均一致)、低不一致(1项参数不一致)、中不一致(2项参数不一致)和高不一致(3项参数不一致)。采用χ^(2)检验比较不同分级组间及质量控制前后的不一致性的差异。随机抽取10例患者,采用组内相关系数(ICC)进行观察者间和观察者内重复性检验。结果196例患者MR分级:轻度31例、中度35例、中-重度51例、重度79例。各组间,重度MR患者组出现完全一致的比例最高(轻度vs中度vs中-重度vs重度:16.13%vs 14.29%vs 0%vs 68.35%,χ^(2)=79.734,P<0.001),中度MR患者组出现低不一致的比例最高(轻度vs中度vs中-重度vs重度:51.61%vs 62.86%vs 41.18%vs 18.99%,χ^(2)=24.012,P<0.001),中-重度MR患者组出现中不一致的比例最高(轻度vs中度vs中-重度vs重度:29.03%vs 17.14%vs 45.10%vs 10.13%,χ^(2)=22.427,P<0.001)。中-重度MR患者组出现高不一致的比例最高,但组间差异无统计学意义(P>0.05)。与质量控制前组相比,质量控制后组不完全一致比例明显降低(58.43%vs 74.77%,χ^(2)=5.899,P=0.015)。观察者间及观察者内重复性较好,ICC均>0.9。结论在MR定量评估过程中,重度组MR程度一致性较其他组高,且质量控制可有效降低不一致性。因此,针对MR定量评估的质量控制需加以普及及重视。Objective To summarize the problems and improvements in the quantitative assessment of mitral regurgitation(MR)by echocardiography.Methods We retrospectively analyzed the image sequences of 196 patients who underwent MR evaluation by echocardiography from August 2021 to April 2023 at the Renmin Hospital of Wuhan University.The patients were divided into a pre-quality control group and a post-quality control group.The control group consisted of 107 patients who underwent MR evaluation between August 2021 and August 2022,while the observation group consisted of 89 patients who underwent MR between September 2022 and April 2023.According to the 2017 American Society of Echocardiography guidelines and standards,the degree of MR was divided into four grades(mild,moderate,moderate-severe,and severe).The inconsistency between the grade to which four quantitative parameters,namely,vena contracta width(VCW),effective regurgitant orifice area(EROA),regurgitant volume(RVol),and regurgitant fraction(RF),belonged and the degree of regurgitation within each grade group was counted and classified as complete consistency(all 4 parameters were consistent),low inconsistency(1 parameter inconsistent),medium inconsistency(2 parameters inconsistent),and high inconsistency(3 parameters inconsistent).Theχ^(2) test was used to compare the differences in inconsistency between various grade groups and before and after quality control.The intraclass correlation coefficient(ICC)was utilized for the repeatability test.Results Among the 196 MR patients,there were 31,35,51 and 79 cases in the mild group,moderate group,moderate-severe group,and severe group,respectively.In the mild,moderate,moderate-severe,and severe groups,the percentages of complete consistency,low inconsistency,moderate inconsistency,and high inconsistency were 16.13%,51.61%,29.03%,and 3.23%,14.29%,62.86%,17.14%,and 5.71%,0%,41.18%,45.10%,and 13.73%,and 68.35%,18.99%,10.13%,and 2.53%,respectively.Patients with severe MR had the highest percentage of complete consistency(mil

关 键 词：超声心动描记术 二尖瓣反流 质量控制 

分 类 号：R540.45[医药卫生—心血管疾病] R542.51[医药卫生—内科学]